Stress and Oral Health

Eric T. Stoopler, DMD


May 30, 2012

Effect of Stressful Life Events on the Onset and Duration of Recurrent Aphthous Stomatitis

Huling LB, Baccaglini L, Choquette L, Feinn RS, Lalla RV
J Oral Pathol Med. 2012;41:149-152

Study Summary

The effects of stress on general and oral health are increasingly recognized. A new study by Huling and colleagues has yielded preliminary data on the effects of both mental and physical stress on the initiation and duration of recurrent aphthous stomatitis (canker sore) episodes. The aims of this study were to evaluate the effects of both magnitude of stress and type of stressful life events on the onset and duration of recurrent aphthous stomatitis episodes experienced by a study population of 160 patients.

The major conclusions of the study were:

  • Experiencing a stressful life event significantly increased the risk for an episode of recurrent aphthous stomatitis within 7 days of the event, but had no effect on the duration of the episode;

  • Both mental stressors (eg, death of a family member) and physical stressors (eg, physical trauma or illness) significantly increased the risk for an episode of recurrent aphthous stomatitis, but not the duration of an episode; and

  • When controlled for each other, mental stressors seem to have a larger effect than physical stressors in overall risk for recurrent aphthous stomatitis episodes.


Stress is prevalent in our society and is encountered in various ways. Stress has been defined as the biological reaction to any adverse internal or external stimulus -- mental, physical or emotional -- that tends to disturb an organism's homeostasis.[1]

Short-term stress is common and is often viewed as positive because it can stimulate creative thinking and enhance problem-solving skills and poses little risk to the overall health of an individual.[1] Chronic stress is often more problematic and has been linked to significant alterations of the endocrine and central nervous system regulatory pathways.[2] Emerging evidence identifies stress, including psychological stress, as an important and modifiable risk factor for both acute and chronic cardiovascular disorders.[3] Other chronic conditions that have been associated with stress include immune dysregulation; type 2 diabetes; obesity; and a wide array of psychiatric disorders, including depression and anxiety.[1,2,3,4]

Oral health may be compromised by these disease processes or by the medications used to treat them, which can negatively affect salivary flow, increase risk for oral infection, and cause inability to maintain adequate oral hygiene. Moreover, stress has been implicated as the initiating factor for oral mucosal lesions (such as recurrent aphthous stomatitis), as demonstrated by Huling and colleagues. Therefore, it is imperative that oral healthcare providers understand the role of stress in the overall management of dental patients. In addition, oral healthcare providers should encourage individuals who seem to have difficulty managing stress to seek additional resources for effective stress management, so that they may reduce their risk for systemic and oral disease.



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